DOCSLIB.ORG

The Use of Oestrogens in Obstetrics and Gynaecology

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Use of Oestrogens in Obstetrics and Gynaecology THE USE OF OESTROGENS IN OBSTETRICS AND GYNAECOLOGY by A. I. S. LACPHERSON , Iú..B., Ch.B. Essay submitted for the Gunning Victoria Jubilee Prize, 1940. The term oestrogen is applied to substances which are characterised by a capacity to restore oestrus or heat in the castrate female animal. The pioneer work of Allen and Doisy (1923), is a landmark in the development of sex endocrinology. By using the vaginal smear which Stockard and Papanicolaou (1917) had shown to undergo definite and constant variations in relation to the separate phases of the oestrus cycle, they demonstrated that a substance could be extracted from the ovary which, when injected into castrate rodents, was active in bringing on heat. No progress was made in the isolation of this substance until it was found that large quantities were excreted in the urine of pregnant animals (Ascheim and Zondek, 1927). The crystallisation of the substance (Butendandt, 1929; Doisy et al., 1929: Larrian, 1929) was early followed by demonstration of its relation to the sterols - one of the most important biochemical groups in normal and abnormal metabolism - and eventually five naturally occurring oestrogens were isolated from the ovary, pregnancy urine and the placenta, all with an identical basic formula (1) and a similar qualitative action cm3 ON C=C SO Ho 3- 2. Of these three are used clinically, viz. Oestradiol (dihydroxyoestrin), Oestrone (ketohydroxyoestrin) and Oestriol (trihydroxyoestrin). That in most common usage to -day is the esterified form of oestradiol known as oestradiol benzoate. STANDARDISATION. Until 1935, standardisation was entirely by biological tests, and, as the criteria adopted by each worker varied, it was impossible to correlate results from different preparations and complete chaos reigned. The Committee on Hormones of the League of Nations Permanent Health Commission laid down as the International Unit for Oestrone the activity of 0.1y, (- .0001mg.) of a standard preparation, and later fixed the International Benzoate Unit (I. B. U.) as the activity of O.1,/of a standard preparation of oestradiol benzoate. By relating the standard to a definite weight of a chemically pure substance the Committee placed Oestrogens on a similar footing to many drugs in the Pharmacopeia, and it is therefore only fitting that oestrogens should be prescribed in milligrams, and not in astronomical numbers of biological units. SYNTHETIC OESTROGENS. It was thought until recently that the cyclo -penteno- phenantlirene nucleus was an essential part of any oestrogenic substance. workers in London and Cambridge (Dodds and Lawson, 1936: Dodds et al., 1938 / 3. 1938 a and b) have ho ever succeeded in synthesizing a surprisingly simple series of compounds which culminated in the production of 4 : 4_ dihydroxy d -0 diethylstilbene (stilboestrol) (2 ),and its derivative dihydrostilboestrol (Hexoestrol). workers in Edinburgh have developed another synthetic compound, triphenylchlorethylene (3) (Robson and Schönberg, 1937). These synthetic compounds have been shown to have an oestrogenic action similar to the naturally occurring oestrogens (Dodds et al., 1938 b: Robson, 1938) and to be highly active orally. It is possible that they are products of the metabolism of oestradiol and have an initial immunity to break- down by the liver. (Shore et al., 1939). ADMINISTRATION. All oestrogenic substances may be given orally, by injection, and locally through mucous membranes. The natural oestrogens are also effective percutaneously provided an organic solvent such as alcohol or benzol is used (Zondek, B., 1938). On oral administration the synthetic oestrogens are all highly active, whereas the ratio of potency by mouth and by injection of pure natural oestrogen is 1:500 (Inhoffen et al., 1938). There is little difference in the duration of action by mouth of the same large dose of oestradiol, oestradiol benzoate, stilboestrol and triphenylchlorethylene (Robson, Schönberg and Fahim, 1938). By injection, speed and duration of action / 4. action depend upon the method emplòyed. Short and concentrated action may be obtained by giving a large number of small doses of the natural hormone in aqueous solution. The substance in this case is rapidly absorbed and rapidly broken down by the body. Slower and more prolonged action results from injection of the oestrogen in an oily solution, and this can be enhanced by injecting the esterified substance, e.g. oestradiol benzoate. Triphenylchlorethylene is characterised by a singularly prolonged action when injected in an oily solution - in animals a demonstrable effect is presont for nearly 20 weeks (Robson, Schönberg and Fahim, 1938), and in man effects have been seen 6 - 9 weeks after two subcutaneous injections at weekly intervals of 250mg. (Macpherson and Robertson, 1939). It is apparent that the absolute activities of the natural and synthetic oestrogens are dependent upon threshold activity, duration of action and intensity of action (Liescher, Scholz and Tschopp, 1938). Consequently, accurate comparison between them for clinical usage is difficult. Oestradiol benzoate by injection and stilboestrol orally have a corresponding threshold activity and approximately the same duration of action, i e. dosage will be similar and will amount to a very few milligrams. The threshold activity of triphenylchlorethylene is approximately 1/10,000 that of oestradiol, but its action is so concentrated and, by injection, so much more prolonged (Robson, 1938) that dosage is not higher in proportion to the difference in threshold / threshold activity. Three points must be borne in mind for successful oestrogenic therapy. .eirstly, the substances do not act instantaneously. Even with frequent small injections of aqueous solution, maximal action does not occur for about 24 - 48 hours, and after administration of an oily solution or by mouth, the latent period is longer than this, probably at least three days. Consequently, where oestrogens are given to make up a deficiency or as an antagonist to another hormone, full clinical effects should not be expected under these times. Secondly, prolonged and continuous treatment will result not only in deleterious local effects in the uterus and breasts, but to some extent in pituitary and hence in ovarian inhibition. dhere prole nged treatment is contemplated, therefore, it should be arranged "in courses ", so that there is an interval during which the organism is subjected to a progressively decreasing quantity of circulating oestrogen, a condition similar to the normal cyclical activity of the follicular hormone. Thirdly, the effects of oestrogen administration are transient, and when the circulating blood oestrin falls below the level of endometrial stimulation, bleeding will occur from the uterus. l.his oestrin withdrawal bleeding appears 5 - 12 days after the cessation or reduction of treatment and can be controA.ed by further oestrogen administration. PHYSIOLOGY / 6. PHYSIOLOGY. The natural ovarian follicular secretion is responsible for the growth and adult development of the secondary sexual apparatus - uterus, vagina and breasts, It is essential for proliferation of the endometrium during the first part of the menstrual cycle and, in its absence, progesterone is unable to induce the secretory changes characteristic of the progestational phase of the cycle. It increases the vascularity and hence the size, and the metabolism of the uterus. Under its influence, both the spontaneous activity and the reactivity of the muscle to the oxytocic principle of the posterior pituitary lobe are increased. It causes cornification of the vagina and increases the cervix. In the breast, it is concerned in the growth of the ductular system and acts with the luteal hormone in stimulating alveolar development (Nelson, 1936). It appears to be antagonistic to, or at any rate to have an inhibitory effect upon the gonadotrophic (Rowlands and Sharpey Schafer, 1940), and lactogenic principles of the anterior pituitary (Nelson, 1936). OVARIAN DEFICIENCY. Clinical usage is rationally determined by the deficiency of some or any ofthese functions. Diminished ovarian secretion commonly leads to the symptoms included under the term "menopausal ". In the menopausal syndrome, disturbances of the autonomic nervous system / 7. system, of such a character as to.- suggest a sympathetic irritability and a parasympathetic depression (Donald, 1937), are outstanding - hot flushes, sweatings, palpitations, tachycardia, coldness of the extremities, migrainous headaches, true menopausal hypertension, urinary sphincteric irritability, obesity - but other neurogenic symptoms of more uncertain origin also occur, for example insomnia, vertigo, emotional instability amounting even to a paranoid psychosis (Strachan and Skottowe, 1933). Amenorrhoea, oligomenorrhoea, frigidity, and varying degrees of atrophy or of failure of development of the secondary sex organs are the characteristic genital symptoms of ovarian deficiency, and certain general effects may also occur - menopausal arthritis, especially of the metacarpal joints (Hanne, 1937) fibrositis, hyperthyroidism, allergic manifestations arising apparently de novo (Donald, 1937), hirsutism, possibly a suprarenal cortical phenomenon (Zondek, H.,1935), and other skin changes. In relation to the syndrome described as menopausal, it is important to notice that a symptomless cessation of the menses ( "menopause ") may be followed some years later by "menopausal" (true "climacteric ") symptoms (Bishop, 1937 b: Donald,
Load more

Recommended publications
  • UWOMJ Volume 25, Number 4, November 1955 Western University
    Western University Scholarship@Western University of Western Ontario Medical Journal Digitized Special Collections 11-1955 UWOMJ Volume 25, Number 4, November 1955 Western University Follow this and additional works at: https://ir.lib.uwo.ca/uwomj Part of the Medicine and Health Sciences Commons Recommended Citation Western University, "UWOMJ Volume 25, Number 4, November 1955" (1955). University of Western Ontario Medical Journal. 244. https://ir.lib.uwo.ca/uwomj/244 This Book is brought to you for free and open access by the Digitized Special Collections at Scholarship@Western. It has been accepted for inclusion in University of Western Ontario Medical Journal by an authorized administrator of Scholarship@Western. For more information, please contact [email protected], [email protected]. Office Gynaecology W. Pelton Tew, M.B., F.R.C.S., Edin. & Can., F.R.C.O.G. The term gynaecology means the treat­ Special articles of equipment: This ment of diseases peculiar to the female would include a biopsy punch (sterilized), genitalia, and office gynaecology, of an Ayres spatula for taking cervical course, refers to the management or treat­ smears, a microscope and suitable stains, ment of the diseases peculiar to the fe­ a small incubator is very handy, insufflator male genitalia and these diseases are such for treating trichamona and some special that one is able to properly manage or solutions or powders used for specific to treat them in the office. Besides this, treatments of trichamona and the yeast of course, there are certain diagnostic fungus, an electric cautery for cervical procedures which may be carried out in catarrh cases.
    [Show full text]
  • Female Infertility: Ultrasound and Hysterosalpoingography
    s z Available online at http://www.journalcra.com INTERNATIONAL JOURNAL OF CURRENT RESEARCH International Journal of Current Research Vol. 11, Issue, 01, pp.745-754, January, 2019 DOI: https://doi.org/10.24941/ijcr.34061.01.2019 ISSN: 0975-833X RESEARCH ARTICLE FEMALE INFERTILITY: ULTRASOUND AND HYSTEROSALPOINGOGRAPHY 1*Dr. Muna Mahmood Daood, 2Dr. Khawla Natheer Hameed Al Tawel and 3 Dr. Noor Al _Huda Abd Jarjees 1Radiologist Specialist, Ibin Al Atheer hospital, Mosul, Iraq 2Lecturer Radiologist Specialist, Institue of radiology, Mosul, Iraq 3Radiologist Specialist, Ibin Al Atheer Hospital, Mosu, Iraq ARTICLE INFO ABSTRACT Article History: The causes of female infertility are multifactorial and necessitate comprehensive evaluation including Received 09th October, 2018 physical examination, hormonal testing, and imaging. Given the associated psychological and Received in revised form th financial stress that imaging can cause, infertility patients benefit from a structured and streamlined 26 November, 2018 evaluation. The goal of such a work up is to evaluate the uterus, endometrium, and fallopian tubes for Accepted 04th December, 2018 anomalies or abnormalities potentially preventing normal conception. Published online 31st January, 2019 Key Words: WHO: World Health Organization, HSG, Hysterosalpingography, US: Ultrasound PID: pelvic Inflammatory Disease, IV: Intravenous. OHSS: Ovarian Hyper Stimulation Syndrome. Copyright © 2019, Muna Mahmood Daood et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: Dr. Muna Mahmood Daood, Dr. Khawla Natheer Hameed Al Tawel and Dr. Noor Al _Huda Abd Jarjees. 2019. “Female infertility: ultrasound and hysterosalpoingography”, International Journal of Current Research, 11, (01), 745-754.
    [Show full text]
  • Some Aspects of Œstrogenic Therapy
    Edinburgh Medical Journal February 1942 SOME ASPECTS OF (ESTROGENIC THERAPY * By W. F. T. HAULTAIN, O.B.E., M.C., B.A., M.B., F.R.C.S.Ed., F.R.C.O.G. I HAVE chosen the subject of cestrogenic therapy for this lectui e for several reasons. The first is that the discovery of the female sex hormones is of comparatively recent origin and, though no doubt there is still much to be discovered with regard to sexual physiology, the work on the natural and synthetic oestrogens has advanced rapidly, with the result that various preparations are even now of the greatest use to the clinician. Secondly, cestrogenic therapy has always been of particular interest to me, even long before I had heard of such a name, and in 1928 I 1 wrote a paper on the administration of ovarian extract for the artificial menopause, gleaned from work which I had been carrying out clinically for five years previously. Since that time I have continued my clinical observations with the various natural and synthetic oestrogenic products which have been introduced, and in this lecture I intend to include my further observations in their appropriate place. Thirdly, special work in the clinical use of has oestrogens been carried out during the last three years in my obstetrical and gynaecological wards. That being so, I intend to deal chiefly in this lecture with conditions with which I have had some clinical experience in regard to the value of oestrogens, and will do no more than refer to other conditions for which have oestrogens been recommended, of which I have no personal experience.
    [Show full text]
  • Niche Role of MRI in the Evaluation of Female Infertility
    Published online: 2021-07-19 OBS AND GYNECOLOGY Niche role of MRI in the evaluation of female infertility Shabnam Bhandari Grover, Neha Antil, Amit Katyan, Heena Rajani, Hemal Grover1, Pratima Mittal2, Sudha Prasad3 Departments of Radiology and Imaging and 2Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, 3Department of Obstetrics and Gynecology, Maulana Azad Medical College, New Delhi, India, 1Department of Radiology, Icahn School of Medicine at Mount Sinai West, New York, USA Correspondence: Dr. Shabnam Bhandari Grover, E-81, Kalkaji, New Delhi - 110 019, India. E-mail: [email protected] Abstract Infertility is a major social and clinical problem affecting 13–15% of couples worldwide. The pelvic causes of female infertility are categorized as ovarian disorders, tubal, peritubal disorders, and uterine disorders. Appropriate selection of an imaging modality is essential to accurately diagnose the aetiology of infertlity, since the imaging diagnosis directs the appropriate treatment to be instituted. Imaging evaluation begins with hystero‑ salpingography (HSG), to evaluate fallopian tube patency. Uterine filling defects and contour abnormalities may be discovered at HSG but usually require further characterization with pelvic ultrasound (US), sono‑hysterography (syn: hystero‑sonography/saline infusion sonography) or pelvic magnetic resonance imaging (MRI), when US remains inconclusive. The major limitation of hysterographic US, is its inability to visualize extraluminal pathologies, which are better evaluated by pelvic US and MRI. Although pelvic US is a valuable modality in diagnosing entities comprising the garden variety, however, extensive pelvic inflammatory disease, complex tubo‑ovarian pathologies, deep‑seated endometriosis deposits with its related complications, Mulllerian duct anomalies, uterine synechiae and adenomyosis, often remain unresolved by both transabdominal and transvaginal US.
    [Show full text]
  • Studies in Human Sterility with Special Reference To
    STUDIES IN HUMAN STERILITY WITH SPECIAL REFERENCE TO THE INVEST IGAT ION OP THE PATENCY AND FUNCTION OP THE FALLOPIAN TUBES AND OP THE CONDITION OP THE ENLOMETRIUM. ProQuest Number: 13849840 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 13849840 Published by ProQuest LLC(2019). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 PREFACE. The thesis which is presented here, consists of two parts &nd an appendix. Part I concerns the pathogenesis, diagnosis and treatment of Human Sterility and is an endeavour to give a comprehensive account of this subject, incorporating a study of much new knowledge and of recent advances which mainly concern technical refinements in the investigation of tubal patency and function, the endometrial cycle and the tfsex hormones.” Only slight reference is made to the male aspect of the problem. In effect, this part of the thesis is almost entirely my contribution to the book ”Sterility and Impaired Fertility” (1959), Hamish Hamilton Medical Books, London, (jointly with C. Lane-Roberts, K. Walker and B.P. Wiesner). The few pages which are included here and which were not written by me are indicated in the text.
    [Show full text]
  • Mayer-Rokitansky-Kuster-Hauser Syndrome with Hyperprolactinemia
    Case Reports Mayer-rokitansky-kuster-hauser syndrome with hyperprolactinemia Dania H. Al-Jaroudi, MBBS, ABOG, Ayda M. Nasser, MBBS. ABSTRACT Address correspondence and reprint request to: Dr. Dania H. Al-Jaroudi, Consultant Obstetrics and Gynecology, Reproductive Medicine Unit, Minimally Invasive Gynecologic Surgery, Reproductive Medicine Unit, Women’s Specialized Hospital, King Fahad Medical City, PO إن ترافق متﻻزمة ماير روكتنسكي كوستر هاوسر )MRKH( مع Box 59046, Riyadh 11525, Kingdom of Saudi Arabia. Tel. +966 (1) :Ext. 8503. Fax. +966 (1) 2889999 Ext. 3714. E-mail 2889999 فرط بروﻻكتني الدم نادر جداً. هنا نستعرض حالة فتاة سعودية [email protected] تبلغ من العمر 18 ًعاما، غير متزوجة، عذراء، حضرت مع والدتها بطلب استشارة طبية بشأن غياب الطمث لديها. كانت لديها أثداء طبيعية، شعر إبط وعانة متطور بشكل طبيعي، فرج طبيعي ,ayer in 1829, followed by Rokitansky in 1838 مع إهليل وأشفار طبيعية، ولكن كان لديها مهبل اعور بطول 2cm Mwere the first to describe mullerian agenesis تقريبا. أظهر تصوير الرنني املغناطيسي للحوض مبايض or Mayer-Rokitansky-Kuster-Hauser syndrome 1 ذات مظهر طبيعي ورحم صغير بدون نسيج بطاني، وعنق رحم MRKH). The syndrome is defined as the absence) ومهبل صغيرين. كما أظهرت اﻻستقصاءات مستويات عالية of the vagina with variable uterine development that للبروﻻكتني في املصل )1,517mIU/L .( نتائج تصوير الرنني results from agenesis or hypoplasia of the mullerian 2 املغناطيسي MRI للقحف كان طبيعيا. مت تشخيص املريضة AFS 1 duct system. Classically, affected women have primary amenorrhea with normal secondary sexual على أنها حالة نقص تصنع قناة مولر درجة ) (. بعد (characteristics,3 hypothalamic-pituitary-ovarian (HPO البحث املوضوعي املكثف، قدمنا أول حالة مسجلة ملتﻻزمة ماير axis, and 46XX female karyotype.4 We report a female روكتنسكي كوستر هاوسر )MRKH( على هيئة نقص تصنع .with MRKH in association with hyperprolactinemia للرحم مع فرط بروﻻكتني الدم.
    [Show full text]
  • THE EOLE of the ENDOCRINE GLANDS in CERTAIN MENSTRUAL DISORDERS Emil Novak, Baltimore, Md. Speaking Generally, • the Importanc
    THE EOLE OF THE ENDOCRINE GLANDS IN CERTAIN MENSTRUAL DISORDERS WITH SPECIAL REFERENCE TO PRIMARY DYSMENORRHOEA AND FUNCTIONAL UTERINE BLEEDING* Emil Novak, Baltimore, Md. (From the Gynecological Department of Johns Hopkins University) Speaking generally, • the importance of the hormone asso- ciations of an organ or of a body function varies with the de- gree of its automaticity. The highly volitional functions, such as the skeletal muscular movements, are under the control of the rapidly acting nerve mechanism, while the auxiliary influence of the endocrine apparatus is relatively slight. "With the more primitive vegetative functions the reverse is true, for here the mechanism is usually essentially of the endocrine type, with a greater or less degree of contributory regulating influence on the part of the sympathetic nervous system. Menstruation is a function which may certainly be classed as vegetative, and hence it is not surprising that tne explanation of its mechanism is to be sought chiefly in a study of the func- tions of certain endocrine glands, and that the cause of menstrual disorders is not infrequently to be found in disorders of these structures. That there is, even in the case of menstruation, some association with the higher centers, is shown by the occasional occurrence of menstrual aberrations under the influence of pro- found psychic disturbances—the amenorrhea which is often seen in women who dread pregnancy, or in those with an intense longing for it; the occurrence of either amenorrhea or excessive menstruation as a result of sudden shock or fright, etc. For nearly a hundred years, the ovary has been looked upon as essential to menstruation, but no attempt was made to explain the manner in which its influence is exerted, until the formula- tion of the well-known theory of Pflueger, in 1865.
    [Show full text]
  • Primary Amenorrhoea Caused by Turner Syndrome: a Case Series
    CASE REPORT Bali Medical Journal (Bali MedJ) 2021, Volume 10, Number 2: 553-558 P-ISSN.2089-1180, E-ISSN: 2302-2914 Primary amenorrhoea caused by Turner syndrome: A case series Published by Bali Medical Journal Hilwah Nora1*, Cut Nonda Maracilu2, Mohd Andalas3, Muhammad Hikmawan Priyanto4 ABSTRACT Background: Amenorrhea is a condition where women do not experience menstruation or the cessation of menstrual cycles at reproductive age. Amenorrhea is divided into primary and secondary. Turner syndrome is one example of gonadal dysgensis that cause the most common primary amenorrhea. It is represented by the absence of all or part of the normal second sex chromosome and physical features including short stature, webbed neck, cubitus valgus, pterygium colli, low hairline, edema of the hands and feet, and shield chest. Clinical pictures and karyotype of Acehnesse patients with Turner syndrome are presented in this study. The patients involved in the study were those who came to an endocrinology clinic in a tertiary care center. Case Presentation: We reported four cases of Turner syndrome which were confirmed from anamnesis, physical examination and chromosomal analysis at the Department of Obstetrics and Gynecology in the Fertility, Endocrine and Reproductive Division of RSUD Dr. Zainoel Abidin Banda Aceh. Conclusion: All patients with Turner syndrome had amenorrhea, short stature, bone deformity and underdeveloped primary dan secondary sexual characteristic. Only one case has monosomy X (45, XO), a mosaic chromosomal component was present in the rest of them (45, X with mosaicism). 1Consultant at Department of Obstetrics Keywords: Turner Syndrome, Primary amenorrhea, Gonad dysgenesis. and Gynecology, Faculty of Medicine, Cite This Article: Nora, H., Maracilu, C.N., Andalas, M., Priyanto, M.H.
    [Show full text]
  • Menstrual Disorders in Adolescent Females Donald E
    University of Kentucky UKnowledge Pediatrics Faculty Publications Pediatrics 2010 Menstrual Disorders in Adolescent Females Donald E. Greydanus Michigan State University Hatim A. Omar University of Kentucky, [email protected] Artemis Tsitsika University of Athens, Greece Dilip R. Patel Michigan State University Right click to open a feedback form in a new tab to let us know how this document benefits oy u. Follow this and additional works at: https://uknowledge.uky.edu/pediatrics_facpub Part of the Obstetrics and Gynecology Commons, Pediatrics Commons, and the Physiology Commons Repository Citation Greydanus, Donald E.; Omar, Hatim A.; Tsitsika, Artemis; and Patel, Dilip R., "Menstrual Disorders in Adolescent Females" (2010). Pediatrics Faculty Publications. 263. https://uknowledge.uky.edu/pediatrics_facpub/263 This Book Chapter is brought to you for free and open access by the Pediatrics at UKnowledge. It has been accepted for inclusion in Pediatrics Faculty Publications by an authorized administrator of UKnowledge. For more information, please contact [email protected]. Menstrual Disorders in Adolescent Females Notes/Citation Information Published in Pediatric and Adolescent Sexuality and Gynecology: Principles for the Primary Care Clinician. Hatim A. Omar, Donald E. Greydanus, Artemis K. Tsitsika, Dilip R. Patel, & Joav Merrick, (Eds.). p. 317-411. © 2010 Nova Science Publishers, Inc. The opc yright holder has granted the permission for posting the book chapter here. This book chapter is available at UKnowledge: https://uknowledge.uky.edu/pediatrics_facpub/263
    [Show full text]
  • Primary Dysmenorrhea
    University of Nebraska Medical Center DigitalCommons@UNMC MD Theses Special Collections 5-1-1938 Primary dysmenorrhea Edward E. Lindell University of Nebraska Medical Center This manuscript is historical in nature and may not reflect current medical research and practice. Search PubMed for current research. Follow this and additional works at: https://digitalcommons.unmc.edu/mdtheses Part of the Medical Education Commons Recommended Citation Lindell, Edward E., "Primary dysmenorrhea" (1938). MD Theses. 674. https://digitalcommons.unmc.edu/mdtheses/674 This Thesis is brought to you for free and open access by the Special Collections at DigitalCommons@UNMC. It has been accepted for inclusion in MD Theses by an authorized administrator of DigitalCommons@UNMC. For more information, please contact [email protected]. r PRIMARY DYSMENORRHEA by Edward E. Lindell Senior lhesis Presented to the College of Medicine, University of Nebraska. 1938 Foreword In medicine there are numerous subjects whose etiology and treatment are well supported by experiment­ al evidence. Little or nothing is known of other condit­ ions. Between these two extremes are disease entities of which dysmenorrhea serves as an example. Although certain facts are accepted regarding etiology and treat­ ment, the condition haa not •een well worked out. As a result an inadequate presentation for a working know­ ledge ls given the medical student. The writers curiosity was aroused long ago, noting the periodic discomfort suffered by female members of the family and schoolmates. Since entering the study of medicine the great in­ cidence of pain with the menses has impressed the writer and with this a determination to know the cause and treat­ ment of this socalled minor functional ill.
    [Show full text]
  • Disorders of Function of Reproductive System. 1
    Disorders of function of reproductive system. 1. Rationale. In the structure gynecologic diseases disorders of menstruation occurs in 20% of cases. Different disorders of menstruation result in high working disability, development of neuropsychic complications, invalidism of women. These complications claim for complex approach and joint treatment by physicians of different specialities – gynecologist, endocrinologist, neurologist and others. 1. Objectives (are described in the terminology of professional activity, taking into account the system of classification of the objectives of the respective levels of cognitive, emotional and psychomotor spheres): -To analyze the results of main methods of functional diagnostics in gynecology -To explain The levels of regulation of woman`s genital functions -To suggest tactics of management of patients with hormonal imbalance of female reproductive system. -To classify mestrual disordes (irregularities) -To interpret the results of laboratory and instrumental examinations of the cervix, endometrium, ovaries, depending with fazes of MC, the clinical and biochemical, hormonal studies of blood, results of colpocytologycal examination -To draw a diagram scheme of menstrual cycle --To make the analysis of the methods of functional diagnosis in gynecology -To make up the models of clinical cases with various hormanal pathology in women of reproductive and premenopausal age. 3. The basic level of expertise, skills, abilities, required for learning the topic (interdisciplinary integration ) The name of the previous Acquired skills disciplines Normal Anatomy Structure of female genital organs. Topography of abdominal organs and pelvic organs. Histology Histological structure of the cervix, vulva and endometrium in normal and in pathological conditions. Notmal Physiology Physiological changes occurring in the hypothalamic- pituitary-ovarian system of women and target organs of the sex hormones action at different ages.
    [Show full text]
  • Septate Uterus with Cervical Duplication and Vaginal Septum
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Canadian Association of Radiologists Journal 62 (2011) 226e228 www.carjonline.org Canadian Residents’ Corner / Coin canadien des re´sidents en radiologie Case of the Month #169: Septate Uterus with Cervical Duplication and Vaginal Septum Lan Qian Guo, HonBsc, Ah-Ling Cheng, MD*, Deepak Bhayana, MD, FRCPC Department of Diagnostic Imaging, Foothills Medical Centre, Calgary, Alberta, Canada Clinical Presentation A 40-year-old woman with a recent diagnosis of cervical cancer after an abnormal Pap smear presents for cancer staging. Her pelvic magnetic resonance image (MRI) is shown below (Figures 1e4). Diagnosis Septate uterus with cervical duplication and longitudinal vaginal septum, stage IIa cervical carcinoma. Radiologic Findings A septate uterus with a complete septum arising from the midline fundus, 2 separate cervices, longitudinal septum of the vagina, and a flat external uterine fundal contour are shown in Figures 1 and 2. T2-weighted and gadolinium- enhanced fat-saturated 3D T1-weighted images (Figures 3e5) show a enhancing mass within the left cervix, which extends into the upper aspect of the left vaginal canal. It also appears to extend into the vaginal mucosa anteriorly. Figure 1. Coronal T2-weighted magnetic resonance image of the pelvis, Discussion showing 2 endometrial cavities separated by a septum. The contour of the uterine fundus is flat, with no fundal cleft present. Mu¨llerian duct anomalies have a prevalence that ranges from 0.16%e10% [1]. The cause of most mu¨llerian duct all been shown to cause defects of the developing fetal anomalies remains unclear, and the majority of cases are genital tracts [2].
    [Show full text]